Submit the original
of the completed form in hard copy or facsimile to the appropriate USDA
servicing office.
Customers who have established electronic access
credentials with USDA may electronically transmit this form to the USDA
servicing office, provided that (1) the customer submitting the form is
the only person required to sign the transaction, or (2) the customer has an
approved Power of Attorney (Form FSA-211) on file with USDA to sign for other
customers for the program and type of transaction represented by this form.
Features for transmitting the form electronically are available to those customers with access credentials only. If you would like to establish online access credentials with USDA, follow the instructions provided at the USDA eForms web site.
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Fld Name / |
Instruction |
|
2A Farm No. |
Enter the farm number where this loan commodity was produced. |
|
2B Name and Address of Contact Producer |
Enter the contact producer’s name and address including Zip code. |
|
3 St. & Co. Codes and Loan No. |
Enter the State and county code of the FSA office where your records are maintained. Leave blank if these codes are not known, and enter your loan number only. |
|
4 Year |
Enter the crop year of the commodity under loan. |
|
5A Commodity |
Enter the type of commodity (i.e., corn, soybeans, wheat, etc.). |
|
5B Class (Wheat Only) |
Enter the class, for wheat only. For all other commodities, leave blank. |
|
Fld Name / |
Instruction |
|
6 To |
Enter name and address including Zip code of buyer or warehouse for rotated collateral. |
|
7 Seal and or Receipt Number(s) |
Enter loan seal(s) or receipt number(s). |
|
8 Quantity for Transfer to Storage |
Bushels or cwt the producer plans to move to the storage location in Item 6. |
|
9 and 10 |
Read instructions for required actions to move commodity. No entries are required. |
|
11A – 11C Title/Relationship of the individual signing in Repre-sentative Capacity |
Please read the producer’s statement and sign and date where indicated. Please contact the County FSA Office before signing and dating this document if you have any questions or concerns. Enter the title/Relationship (of the individual signing in the Representative Capacity). If you are mailing or faxing this form, print the form and manually enter your signature. If this form is approved for electronic transmission and you have established credentials with USDA to submit forms electronically, use the buttons provided on the form for transmitting the form to the USDA servicing office. |